You must also report any. The advanced tools of the editor will guide you through the editable PDF template. telephone number ( ) address. .
Form LIC 624, Unique Incident/Injury Report, is an document designed for daily providers such allows them to report unusual incidents and/or trauma to the appropriate California your agencies.
When a vendor makes a report of an event to the Department of Social Services’ Community Care Licensing Division the vendor shall simultaneously report the event.
Child Development Manager.
*Scan a copy of the Unusual Incident Report and CFS report (if one has been made) to the Unusual Incident folder.
F or childcare providers and preschools only: in addition to the above, call Community Care Licensing within the next working day and follow up in 7 days with a written report (Unusual Incident Report Form Lic 624 for Centers and Unusual Incident Report Form Lic 624B for fa mily providers).
After the occasion, an incident report ought to be completed as soon as possible to get the most. PLEASE COMPLETE NON-SHADED AREAS IN FULL. . (D) Any suspected physical or psychological abuse of any child.
. . Phone: (408) 324-2148 or fax (408) 324-2160.
such as “any unusual incident or client absence which threatens the physical or emotional health or safety of any client” or “any suspected physical or psychological abuse of any client.
), and 4) sketches (when appropriate). Rate free lic.
Cross References. .
Jan 22, 2021 · As stated previously, all unusual occurrences shall be reported to CDA, the center’s CDPH Licensing District Office, and the participant’s MCP within 24 hours of the occurrence.
. Child Development Manager. a separate unusual incident report does not need to be submitted if all required information is provided. The advanced tools of the editor will guide you through the editable PDF template.
community care licensing division. 2. 1 business day. .
LIC 624B (8/08) - Unusual Incident/Injury Report - Family Child Care Home; LIC 624 LE (12/22) - Law Enforcement Contact Report;. Instructions for Completing SARC SIR. 2.
Phone: (408) 324-2148 or fax (408) 324-2160.
gov or use our online complaint webpage. submit written report within 7 days of occurrence. .
witnesses or participants, etc. Community Care Licensing Division Welcome to the Community Care Licensing Division. 2. Unusual Incident Report.